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Table 3 Comparing clinical characteristics, referral pathways and TB treatment outcomes of children by two complementary hospital-based surveillance strategies

From: Complementary surveillance strategies are needed to better characterise the epidemiology, care pathways and treatment outcomes of tuberculosis in children

 

All identified through laboratory surveillance n = 158 (40.0%)a

Identified through clinical surveillance only n = 237 (60.0%)a

Odds Ratio (95% CI)

p-value

Demographics and admission characteristics

 Age (years)

  0 - < 2

63 (39.9)

117 (49.4)

Reference

 

  2 – < 5

48 (30.4)

68 (28.7)

1.3 (0.8–2.1)

0.269

  5 – < 13

47 (29.8)

52 (21.9)

1.7 (1.0–2.8)

0.042

 Male sex

77 (48.7)

136 (57.4)

0.7 (0.5–1.1)

0.092

 In-patient admissions

138 (87.3)

223 (94.1)

0.4 (0.2–0.9)

0.019

  Duration of hospitalisation

    ≤ 1 week

46 (33.3)

77 (34.5)

Reference

–

   2–3 weeks

68 (49.3)

100 (44.8)

1.1 (0.7–1.8)

0.595

    ≥ 4 weeks

24 (17.4)

46 (20.6)

0.9 (0.5–1.6)

0.666

TB History

 Previous TB treatment reported

7/150 (4.7)

19/221 (8.6)

0.5 (0.2–1.3)

0.146

 Any TB exposure reported

77/154 (50.0)

136/230 (59.1)

0.7 (0.5–1.0)

0.078

  Household TB exposure reported

50/69 (72.5)

93/126 (73.8)

0.9 (0.5–1.8)

0.781

HIV and nutritional status

 HIV status documented

146 (92.4)

224 (94.5)

0.7 (0.3–1.6)

0.400

  HIV-infected (of those tested)

18/146 (12.3)

72/224 (32.1)

0.3 (0.2–0.5)

< 0.001

 Weight-for-Age Z-score < − 3b

53/153 (34.6)

60/230 (26.1)

1.5 (1.0–2.3)

0.073

TB disease characteristics

 Spectrum of TB disease

  PTB only

63 (39.9)

144 (60.8)

Reference

 

  ETPB with/without PTB

95 (60.1)

93 (39.2)

2.3 (1.5–3.6)

< 0.001

 Disseminated TB

  TB Meningitisc

20 (12.7)

42 (17.7)

0.7 (0.4–1.2)

0.176

  Miliary TBc

19 (12.0)

5 (2.1)

6.3 (2.3–17.8)

< 0.001

 Type of TB treatment

  First-line regimen

134/156 (85.9) d

208/237 (87.8)

Reference

–

  Any drug-resistant regimen

22/156 (14.1) d

29/237 (12.2)

1.2 (0.7–2.1)

0.591

Deaths during hospital admission

7 (4.4)

2 (0.8)

5.4 (1.1–26.9)

0.033

Discharge referral pathway for continuation of TB caree

 Community-based PHC facilities

93/151 (61.6)

151/235 (64.3)

Reference

 

 Hospital-based outpatient follow-up

9/151 (6.0)

19/235 (8.1)

0.8 (0.3–1.8)

0.537

 TB hospitals

37/151 (24.5)

45/235 (19.2)

1.3 (0.8–2.2)

0.263

 Otherf

12/151 (8.0)

20/235 (8.5)

1.0 (0.5–2.1)

0.946

TB treatment outcomes (DS-TB)

 Favourable

119/136 (87.5)

181/208 (87.0)

1.0 (0.5–2.0)

0.896

 Unfavourable

17/136 (12.5)

27/208 (13.0)

Reference

 

TB treatment outcomes (DR-TB)

 Favourable

22/22 (100)

28/29 (96.6)

–

1.000

 Unfavourable

0/22 (0.0)

1/29 (3.5)

  
  1. aThe denominator was 158 or 237 respectively, unless otherwise specified due to missing data
  2. bWeights were transformed to z-scores using the LMS method and the reference data available from 1990 British Growth Reference.; missing admission weights (n = 10)
  3. cInlcudes 9 children that had both miliary TB and TB meningitis
  4. dExcludes two children that died during hospital admission before TB treatment was initiated, but subsequently had a positive culture for drug-susceptible TB
  5. eExcludes children who died in-hospital (n = 9)
  6. fIncludes referrals to secondary hospitals (n = 23), chronic medium term care facilities (n = 8) and one child that completed TB treatment during a non-TB related admission
  7. TB Tuberculosis, CI Confidence interval, HIV Human immune-deficiency virus, ART Antiretroviral treatment, PHC Primary healthcare, DS Drug-susceptible, DR Drug-resistant
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BMC Public Health

ISSN: 1471-2458

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